Hospital readmission rates remain stubborn. Hoping to move the needle, Highmark Blue Cross Blue Shield has made its care transition program, which tracks readmissions indicators, mandatory for hospitals that have failed to meet a certain threshold.

To that end, Highmark Blue Cross Blue Shield has operated a pay-for-performance program called Quality Blue for many of its network hospitals since 2001. The program tracks 15 indicators of care quality and patient safety. Typically it allows the participating hospitals to select their focus indicators. Depending on their size, hospitals select between one and four indicators to help them track improvements each year.

Readmission rates remain stubborn, and there is some disagreement over to what extent hospitals can influence them. So in 2012, with CMS's 30-day readmissions penalty about to become a reality, Highmark decided to make its readmissions indicator mandatory for hospitals that failed to meet a threshold score.

Through the Pittsburgh-based insurer's "defect-free transitions of care bundle," 68 hospitals embarked on a program to reduce inpatient readmissions.